MENA-Adapted Guidelines for Aneurysmal Subarachnoid Hemorrhage

A Regional Approach to Global Evidence

These guidelines provide evidence-based recommendations for aSAH management adapted to the diverse healthcare landscapes of the Middle East and North Africa (MENA) region. Developed by the MENA Stroke and Interventional Neurotherapies Organization (MENA-SINO), they address critical regional challenges while maintaining core principles of care.

Key Statistics

Incidence Rate

3.8-5.7

per 100,000

Annual incidence across MENA region

Mortality Rate

12-35%

in-hospital

Varies by resource availability

Expert Panel

45+

specialists

From across MENA countries

Countries

20+

MENA nations

Represented in guidelines

Regional Challenges

Urban-Rural Disparities

high

85% of neurosurgical beds concentrated in 3 major cities in some countries

Specialist Access

high

Neurosurgeon-to-population ratio ranges from 1:250,000 to 1:1,300,000

Treatment Delays

medium

Average 62 hours in limited-resource settings vs 18 hours in comprehensive centers

Economic Barriers

high

Out-of-pocket expenses range $2,500-$45,000 depending on country and treatment

Conflict-Affected Areas

critical

50%+ healthcare infrastructure damaged in Syria, Yemen, parts of Libya

Refugee Populations

high

17+ million refugees face 3.2x longer treatment delays

Methodology

These guidelines were developed using the MENA-SINO framework for guideline adaptation, incorporating:

Comprehensive Evidence Review

Multiple international guidelines including AHA/ASA, ESO, NICE, Neurocritical Care Society, and Chinese guidelines

Regional Literature Search

142 MENA-specific publications and dataset analyses

Multidisciplinary Panel

Representation from neurosurgery, interventional neuroradiology, neurocritical care, and research methodology

Geographic Diversity

Input from various MENA healthcare systems, including conflict-affected areas

Modified Delphi Process

Three rounds achieving >85% agreement on final recommendations

Resource Considerations

Resource-Limited (RL) tags and Expert Opinion (EO) statements for region-specific issues

Endorsed By

• Tunisian Interventional Radiology Association (TIRA)

• Egyptian Society of Interventional Radiology (EGSIR)

• Neuro Radiology Society of Pakistan (NRSP)

• Egyptian Society of Neurological Surgeons (ESNS)

• Iranian Stroke Association (IRSA)

• Saudi Association of Neurological Surgery (SANS)

• Oman Stroke Society (OSS)

• ASEAN Neuro Interventional Association (ANIA)

• Turkish Cerebrovascular Diseases Society (TCVDS)